Radiography of Implantable Arrhythmia Management Devices

Radiographic evaluation is often helpful after placement of pacemakers, implantable cardioverter-defibrillators (ICDs), and devices for cardiac resynchronization therapy (CRT). Important information may be missed if the chest radiograph is reviewed in a cursory fashion for adequacy of lead placement and for a pneumothorax following venous puncture for lead placement. Radiographic inspection of an implantable cardiac device system, whether pacemaker, ICD, or CRT device, should be performed in an organized manner (Table 18.1). Without an orderly approach, essential information may be overlooked. Posteroanterior (PA) and lateral chest radiographs from any patient with a permanent pacemaker or ICD should be obtained and reviewed by the implanting physician or follow-up team. Oblique views do not commonly provide a great deal of additional data for most pacemakers and ICDs but may be helpful for better assessment of left ventricular lead placement in some patients with CRT devices.